Outside In

03/04/2026

Corticosteroid injections are the intervention I want to address most directly, because they remain commonly offered and the evidence against them, particularly for long-term outcomes, is consistent and compelling. Cortisone injections for tennis elbow should be avoided in most cases. Let me explain…

A well-designed RCT published in JAMA found that while corticosteroid injections provided superior short-term pain relief at six weeks compared to physiotherapy and watchful waiting, by 12 months the injection group had significantly worse outcomes than both other groups, with higher recurrence rates (Coombes et al. 2013). Short-term relief followed by long-term recurrence and potentially worse tendon biology is not a trade worth making for a condition that resolves on its own. I recommend avoiding corticosteroid injections for this problem.

PRP (platelet-rich plasma) injections are a different conversation, the evidence is more nuanced, and certain PRP preparations may have a role in recalcitrant cases. If you are considering PRP, understand that not all PRP is equal. Preparation technique, platelet concentration, and injection protocols all matter. This is a discussion to have with a physician experienced in PRP for tendinopathy.

03/04/2026

Meniscal tears aren't the crisis the MRI report makes them sound like.
Most people over fifty have meniscal changes on imaging. Most of them have no symptoms at all. The tear was probably there before your knee pain started, and in many cases it will still be there after the pain resolves.

What changes isn't the meniscus. What changes is the capacity of the system around it.
When the muscles that support the knee are strong and the joint is being loaded regularly, the meniscus does its job without complaint. When that support erodes over years of inactivity, the same tissue that was quietly tolerating load for decades starts to speak up. The MRI gets ordered. The tear gets named. Surgery gets proposed.

What does the randomized controlled trial evidence actually show? For the majority of middle-aged adults with degenerative (complex) meniscal tears, a structured physical therapy and loading program produces outcomes equivalent to surgery at one year, and in some studies better at five. The meniscus doesn't need to be treated. The capacity around it does.

This isn't a reason to avoid surgery categorically. There are presentations where it's the right call. But a tear on an MRI in a 52-year-old who stopped exercising a decade ago is not one of them, at least not before a serious attempt at rebuilding what was lost.

Load the system. Most of the time, the knee catches up.

25/03/2026

The Hip Hinge: The Most Important Movement You Probably Never Learned

Most people focus on squats, lunges, or crunches but they neglect the hip hinge, one of the most essential movement patterns for long-term strength and mobility.

What is the hip hinge?
The hip hinge is a controlled movement where you bend at the hips while keeping your spine neutral. Think about picking up a bag from the floor, tying your shoes, or lifting groceries safely. It’s not just an exercise; it’s a foundation for movement that protects your body for life.

Why it matters, especially as we age?
1. Protects your low back. The hip hinge teaches your glutes and hamstrings to absorb load, reducing stress on the lumbar spine.

2. Strengthens your glutes and hamstrings. These muscles are critical for walking, climbing stairs, and standing from chairs safely.

3. Supports your knees. Proper glute and hamstring engagement reduces knee strain.

4. Preserves functional independence. Every time you bend to pick something up, the hip hinge keeps you safe, strong, and confident.

5. Enhances posture and balance. Engaging the posterior chain improves alignment, reducing the risk of falls.

How to start safely?
-Stand with feet hip-width apart.
-Slightly bend your knees and hinge at your hips, pushing your butt backward.
-Keep your spine neutral and chest lifted.
-Engage your glutes and hamstrings as you return to standing.

Start with bodyweight only then gradually add light resistance like a kettlebell, dumbbell, or household object. Focus on form, the movement itself builds strength and durability over time.

23/02/2026

Even as we get older, our bones are still active and still listening to how we use them.

When you move, especially with weight-bearing or gentle resistance like walking, light strength training, stair climbing, or carrying groceries, your bones feel that stress. And that stress isn’t a bad thing. It’s a signal. A message that says,
“We need to stay strong.”

When the body receives that message, it responds by improving bone mineral density and strengthening its internal structure. In simple terms: use it wisely, and your bones work to protect you.

If you’ve been told that bone loss is just part of aging and there’s nothing you can do, that can feel discouraging. While aging changes our bones, they are not helpless. They can adapt. They can respond. They can improve.

You don’t need intense workouts.
You need consistent, safe, progressive movement.
Small efforts done regularly matter more than occasional big efforts.

Stiff joints in the morning?
That’s normal.
Slower recovery? Also normal.
But fragile does not have to be your story.

Your body is still capable.
Your bones are still responsive.
And it is never too late to give them a reason to stay strong.

08/10/2025

It’s easy to convince someone they need surgery for something that doesn’t.
But it’s so hard to convince them to move again when an MRI shows the tiniest flaw.

We’ve learned to fear what we see on a screen more than what we feel in our hearts.
But your body is not broken, its living, breathing, and built to heal.
Pain doesn’t always mean damage.
And stillness doesn’t always mean safety.

Flow gently.
Rise bravely.

Because healing is less about repair and more about remembering your own resilience.

12/06/2025

22/05/2025

Participate in a study of ME/CFS

06/03/2025

Cyclone Alfred (Alf) and clinic closure:
The clinic is currently closed in preparation for Alfs arrival. Hopefully Alf’s temper is low and we are not badly impacted by his mood. But, in the meantime stay at home and stay safe.

23/12/2024

Wishing all a happy, healthy and safe Christmas and New year. And more importantly, thinking of those who may find the festive season especially hard due to loss or illness… wishing you love, strength and understanding for the coming year.

16/12/2024

Polyvagal theory
The pseudoscience that therapists love to believe …

The polyvagal theory proposes a three-pronged, hierarchical model of the autonomic nervous system and says that the vagus nerve plays a central role in coord...

08/12/2024

MF/CFS, long COVID and tick Borne disease in Australia.

Kylie Baxter interviews Dr Richard Schloeffel OAM for ABC’s Drive Program. In this 15 minute interview, Dr Schloeffel discusses Myalgic Encephalomyelitis/Chr...

23/11/2024

Dr. Bashar Badran is an innovator and a trail blazer. His neuroscience research at the Neuro- X Lab includes a wearable tVNS device for relieving pain and thus reducing the reliance on addictive medication.

This device could be a potential game changer for chronic pain management. Information in the link below.

MUSC neuroscientist Bashar Badran was recently recognized for his trailblazing research by the Helping to End Addiction Long-Term Initiative.